If you have osteopenia, you have lower bone density than normal. Your bone density peaks when you’re about 35 years old.
Bone mineral density (BMD) is the measurement of how much bone mineral is in your bones. Your BMD estimates the chances of breaking a bone from a normal activity. People who have osteopenia have a lower BMD than normal, but it’s not a disease.
However, having osteopenia does increase your chances of developing osteoporosis. This bone disease causes fractures, stooped posture, and can lead to severe pain and loss of height.
You can take action to prevent osteopenia. The right exercise and food choices may help keep your bones strong. If you have osteopenia, ask your doctor about how you can improve and prevent worsening so you can avoid osteoporosis.
Osteopenia doesn’t usually cause symptoms. Losing bone density doesn’t cause pain.
Aging is the most common risk factor for osteopenia. After your bone mass peaks, your body breaks down old bone faster than it builds new bone. That means you lose some bone density.
Women lose bone more quickly after menopause, due to lower estrogen levels. If you lose too much, your bone mass may drop low enough to be considered osteopenia.
About half of Americans older than age 50 get osteopenia. The more of these risk factors you have, the higher your risk is:
- being female, with small-boned women of Asian and Caucasian descent having the highest risk
- family history of low BMD
- being older than age 50
- menopause before age 45
- removal of ovaries before menopause
- not getting enough exercise
- a poor diet, especially one lacking calcium and vitamin D
- smoking or using other forms of tobacco
- drinking too much alcohol or caffeine
- taking prednisone or phenytoin
Certain other conditions can also increase your risk of developing osteopenia:
Who should be tested for osteopenia?
The National Osteoporosis Foundation recommends that you have your BMD tested if you’re:
- a woman age 65 or older
- younger than 65, postmenopausal, and have one or more risk factors
- postmenopausal and you’ve broken a bone from a normal activity, like pushing a chair to stand up or vacuuming
Your doctor may recommend that you have your BMD tested for other reasons. For instance, about one in three white and Asian men older than age 50 have low bone density.
Dual energy X-ray absorptiometry, called DEXA or DXA, is the most common way to measure BMD. It’s also known as a bone mineral density test. It uses X-rays that have lower radiation than a typical X-ray. The test is painless.
DEXA usually measures bone density levels in your spine, hip, wrist, finger, shin, or heel. DEXA compares the density of your bone to the density of a 30-year-old’s of the same sex and race. The result of a DEXA is a T-score, which your doctor can use to diagnose you.
|+1.0 to –1.0||normal bone density|
|–1.0 to –2.5||low bone density, or osteopenia|
|–2.5 or more||osteoporosis|
If your T-score shows you have osteopenia, your DEXA report may include your FRAX score. If it doesn’t, your doctor can calculate it.
The FRAX tool uses your bone density and other risk factors to estimate your risk of breaking your hip, spine, forearm, or shoulder within the next 10 years.
Your doctor may also use your FRAX score to help make decisions about treatment for osteopenia.
The goal of treatment is to keep osteopenia from progressing into osteoporosis.
The first part of treatment involves diet and exercise choices. The risk of breaking a bone when you have osteopenia is fairly small, so doctors don’t usually prescribe medicine unless your BMD is very close to the osteoporosis level.
Your healthcare provider might talk to you about taking a calcium or vitamin D supplement, although generally it’s better to get enough of each from your diet.
To get calcium and vitamin D, eat nonfat and low-fat dairy products, such as cheese, milk, and yogurt. Some types of orange juice, breads, and cereals are fortified with calcium and vitamin D. Other foods with calcium include:
- dried beans
- wild fresh water salmon
To see if you’re getting the right amount of these nutrients for your bones, you can use the calcium calculator on the International Osteoporosis Foundation site. The calculator uses grams as its unit of measurement, so just remember 30 grams is about 1 ounce.
The goal for people with osteoporosis is 1,200 milligrams of calcium a day and 800 international units (IU) of vitamin D. However, it isn’t clear whether this is the same for osteopenia.
If you have osteopenia, are a young adult, and are a premenopausal female, walking, jumping, or running at least 30 minutes on most days will strengthen your bones.
These are all examples of weight-bearing exercises, which means you do them with your feet touching the ground. While swimming and biking may help your heart and build muscles, they don’t build bones.
Even small increases in BMD can significantly reduce your risk for fractures later in life.
However, as you get older, it becomes much harder for you to build bone. With age, your exercise should emphasize muscle strengthening and balance instead.
Walking is still great, but now swimming and biking count too. These exercises can help reduce your chances of falling.
It’s always a good idea to talk with your doctor about the best and safest exercises for you.
In addition to walking or other exercise, try these strengthening exercises:
Hip abductors strengthen your hips and improve balance. Do this two or three times a week.
- Stand sidewise next to a chair and hold onto it with one hand. Stand straight.
- Put your other hand on top of your pelvis and raise your leg out and to the side, keeping it straight.
- Keep your toe pointed forward. Don’t raise so high that your pelvis rises.
- Lower the leg. Repeat 10 times.
- Change sides and do the same exercise 10 times with your other leg.
Toe and heel raises
Toe raises and heel raises strengthen lower legs and improve balance. Do them each day. Wear shoes for this exercise if you have pain in your feet.
- Stand facing the back of a chair. Lightly hold onto it with one or both hands, however you need to stay balanced. Work up to being able to stay balanced using just one hand or a few fingers.
- Stand straight.
- Keep your heels on the ground and lift your toes off the floor. Keep standing straight with your knees straight.
- Hold for 5 seconds. Then lower your toes.
- Rise up on your toes, imagining that you’re moving your head up to the ceiling.
- Hold for 5 seconds. Stop if you have a muscle cramp.
- Slowly lower your heels back to the floor.
- Repeat 10 times.
Prone leg lifts
Prone leg lifts strengthen your lower back and buttocks and stretch the front of your thighs. Do this exercise two to three times a week.
- Lie on your stomach on a mat on the floor or on a firm bed.
- Put a pillow under your abdomen so when you lift your leg you’re just coming up to a neutral position. You may rest your head on your arms or put a rolled-up towel under your forehead. Some people like to put a rolled towel under each shoulder and under their feet as well.
- Take a deep breath, gently press your pelvis against the pillow, and squeeze your buttocks.
- Slowly raise one thigh off the floor, with your knee slightly bent. Hold for a count of 2. Keep your foot relaxed.
- Lower your thigh and hip back to the ground.
- Repeat 10 times.
- Do 10 with the other leg.
The best way to prevent osteopenia is to avoid or stop any of the behaviors that cause it. If you already smoke or drink a lot of alcohol or caffeine, stop — especially if you’re younger than age 35, when you can still build bone.
If you’re older than age 65, your doctor will likely suggest a DEXA scan at least once to look for bone loss.
People of all ages can help their bones stay strong by maintaining a healthy diet, making sure they get enough calcium and vitamin D. In addition to food, another way to get vitamin D is with a small amount of sun exposure. Talk with your doctor about safe sun exposure based on your other health conditions.
Can osteopenia be reversed?
Osteopenia can be stabilized and even improved. Your goal would be to identify the risk factors and change the ones you can. For instance, stopping smoking, or minimizing the dose of steroids, or effectively controlling inflammation associated with diseases like rheumatoid arthritis. Diet and exercise can improve bone density.Nancy Carteron, MD, FACRAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.